Monday, August 25, 2008

An Overdue Recap of Costa Rica

It is hard to sum up in a few paragraphs what an experience like Costa Rica was.  For 6 of us (7 if you count our adopted Psychiatrist from Cambridge Hospital) it was an immersion of intense language classes and of cultural clashes, in the most harmless sense of the word.  For 3 of us, who are native Spanish speakers, it was a challenge to our developing professional psychological selves, as well as a mutual sharing of differences among the Latino cultures.  

While our classmates enjoyed the rigorous task of learning the subjunctive, preterite (perfect & imperfect), and "jerundio".... the native speakers were out getting our feet wet with individual clients twice a week, with group work with adolescent girls' shelters (one which included teen mothers) involving psychometric testing, and with visiting clients at a hospital whose sole purpose was to provide palliative services to terminally ill cancer patients at minimal cost to them and their families.  Though exhausting and challenging at times, the benefits reaped from such experiences are invaluable.

On an individual level, the clients attending sessions at the Rancho were determined to make the most of their 4 - 5 sessions. They consistently showed up on time to their scheduled appointments and gave their 100% cooperation in wanting to seek change for the betterment of their lives. We saw sons, daughters, mothers, and even folks who got their neighbors to "tag along" for treatment.  Personally, it was remarkable to see how such few sessions could really make such a difference in people's lives. I'll never forget one woman in particular who came to therapy seeking advice on how to "feel less guilty about standing up to my mother."  This was a 42-year-old woman who had been completely overpowered in every way by her mother since childhood. By the end of our time together she was making statements like, "I have the power to take control of my own marriage, my own household, and my own mother's burdens are her own backpack to carry, not mine."  Her change was remarkable.  Mostly it was the act of being heard and of being understood that helped this woman.  Just a simple reminder that she too was a person of value in the world, whose opinion also mattered. 

Equally striking was the positive energy we received from the terminally ill cancer patients at the hospital.  Do~na  Alice in particular was a 94-year-old woman full of wisdom, courage, and most of all laughter and lo
ve.  Spending time with her made one forget the reason she was there to begin with. I know I can speak for the 3 of us, that she will remain in our hearts forever.  

Lastly, but surely, we have our adolescent girls who reminded us that although troubled by extensive trauma histories and dysfunctional families, they still found a way to remain youthful, to find the positive side of educating themselves, and to embrace their individuality as a person.  They welcomed us with open arms and saw us as their equals. Fascinated by our cultural diversity (Puerto Rico, Peru, and Argentina), they asked millions of questions, yet treated us like their own. 

We are also grateful to our Tica family who made us feel right at home. Do~na Carmen not only treated us like part of the family, but she also
 kept our bellies full of delicious native food 2 times a day.  Thanks to her, our repertoire of Spanish recipes has considerably grown.  So much so that some of us couldn't help but bring back some of their country's products (e.g., Salsa Lizano!).  

A HUGE thank you to MSPP who supported us in this endeavor. Without your investment and belief in us, we would not have had the opportunity to have such an enriching experience.  This is indeed a worthy cause that is much needed and much appreciated, both by the professionals themselves and by our targeted population in need.

Tuesday, August 12, 2008

A candid conversation: Zack and Juan

Ever since the invention of language, people have had many deep conversations. We're all familiar with Freud's conversations with Jung. The following is not one of those, however we hope you enjoy it.

Zack - What has been the single most exciting experience thus far on your trip?
Juan – Other than the work we’ve been doing as a team at the hospital I’d have to say hiking halfway to the summit of the mountain in Quito. It was a great experience because it was spontaneous and unexpected. Because I had not acclimated to the altitude, there were many times when I felt light-headed and tired; however, something kept me going and in a way this experience helped me realize how far I can push myself.

J - What is one thing that you want to do before this trip is over?
Z- I think there are a number of things that I want to accomplish in regards to the hospital work, the school and even in a more social aspect. For the hospital, I want to take in as much as possible and feel like I was able to leave a positive mark, for both patients and other clinicians. For the school, I’m really looking to improve my Spanish so I’ll be able to converse more proficiently with Spanish speaking patients. In addition, I think it is important to immerse yourself into the social scene. This may, or may not include, soccer games, discotheques and traveling to different places in Ecuador.

Z- What have been some of the more difficult aspects that you have had to deal with since you have been here in Ecuador?
J – One of the most difficult things for me has been adapting myself to the schedule that people follow here in Ecuador. It’s difficult to start the morning at six thirty, get some work done for four hours at the hospital, have a three hour break then go back for another three hour block for classes. I finally come home at eight for dinner. It has been challenging for me to find time for myself because so much of our time is allotted for certain activities (work, school, and the many meetings we have a week). However, I have been able to include working out at the school’s gym which has helped me burn many of the carbs we consume via mounds of rice during lunch and dinner.

J- What is your favorite aspect of the Ecuadorian culture?
Z- I would have to say I’m a fan of how relaxed people are here. When we were in Costa Rica we would talk about “Tico” time, because people would usually show up a bit later than expected. Here in Ecuador, we’re having a similar experience. Growing up on the East Coast, where you’re expected to do everything quickly and efficiently is much different from the laid back attitude they have here and in Costa Rica. There’s definitely something to be said about taking things a little slower and appreciating the time you have.

Z-We have had some extremely insightful and fulfilling experiences in the hospital. We have also had some real difficult experiences in the hospital. Can you tell me about one of the experiences that have been more difficult or upsetting?
J – We have been working with a patient for the course of two weeks. At the end of the second week we terminated with him and, as with all terminations, it was difficult to deal with. However, upon our return to the hospital the following Monday we saw him walking around the halls. We then learned that through some clerical misunderstanding and miscommunication between staff his discharge date was moved a week later. We continued working with this patient and at the end of that week we terminated once more which was again difficult. A day later we learned that again he was going to stay for a couple of more days due to a last minute med change. A couple of days later he was finally released from the hospital and although it was a difficult situation to deal with, in the end it was gratifying to know that we were able to put our feelings aside and focus instead on the well-being of the patient. It was great that we were also able to advocate for him in a very positive and proactive manner until his discharge from the hospital.

J- Tell me about a patient you have felt a strong connection with and how that occurred?
Z- At this point I feel like I’ve had a few patients with whom strong connections have been built. For me personally, this work seems slightly difficult because I’m not fluent in Spanish. Some of the patients are heavily medicated and some patients are severely mentally ill, both of which can make communication quite difficult. Nevertheless these patients are still looking for a human connection, which is something as clinicians we can offer without using language.

Z- For those out in blog land who know the six of us, they know we like to have fun. They also know that we can all be a little silly and funny. What has been one extremely funny or memorable experience from this trip?
J- How do you pick just one moment from the many that we have had? We could talk about having dinner with Amaro and listening to his stories about “When I was your age…”, or we could talk about the constant cell phone use by our new found Ecuadorian friends during inappropriate times and our facial reactions as we try to make sense of it. But for me, the most memorable experience has been the long rides on the bus as we get to and from our weekend trips. It is hard not to laugh as I think about being surrounded by seven children jumping and screaming and having spit wars for three straight hours as I am trying to get some sleep. Nothing is funnier than hearing Jeanine say out loud “ok that’s enough” in her futile attempt to quiet the kids. I also can’t help but laugh when I think about finally falling asleep on the bus only to be woken up thirty seconds later by some little kid climbing up on my lap while loudly calling out “señor, señor”.

Tuesday, August 5, 2008

Hola Amigos!
As our time in Guayaquil is coming to an end I thought I would post an update. We continue to work in the psychiatric hospital and finally the clouds are beginning to clear. Not so long ago many of us found it extremely difficult to follow and understand the patients. For reasons of language, medication, and psychosis, understanding and following the patients presented as an impossible task. Finally, I find myself less confused and less in need of clarification. Many patients have responded to our group of ¨norteamericanos¨ with enthusiasm and excitement, which has enriched our cross-cultural clinical experience. We have also had the opportunity to visit other health facilities in the city including a community health center, Hansen Disease hospital and a cancer hospital. During each visit we are given a tour by a psychologist and informed about the role of psychology in the specific facility.
We are savoring the last couple weeks and soaking up as much Spanish as possible. So of us continue to travel on the weekends while others stay in town and become familiar with Guayaquil. We have traveled to various cities in Ecuador and observed vast differences among regions. We have noticed drastic changes in climate, language and dress within the country. While we cannot fully understand and comprehend the impact of this trip and experience at the present moment, we continue to process our experience together over cafe and pan de yuca (coffee and yuca bread) almost daily.

Hope all is well back in Boston!

Christina Massari

Hola from Ecuador

We are in the midst of quite an adventure here in Guayaquil, Ecuador! Now in our fourth week, I feel that we have learned so much in the way of the culture of mental health yet for every question answered, two more come to mind. We have mosty been interning at a large psychiatric hospital but some of us have had the opportunity to visit other sites around the city. Last week I went to a clinic in a very poor neighborhood where there is no running water or sewage. This small clinic, made up of a physician, an obstetrician, a dentist and a psychologist services 120,000 people. They rely on foreign volunteers to run their lab which would otherwise shut down. The psychologist there was kind enough to let me sit in on a session as well as invite me back to participate in a weekly community psychoeducational meeting. I also had the opportunity to visit a site that provides support, medical treatment and housing to people with Hansen`s disease, more commonly known as leprosy. Many of the residents at this site have been abandoned by their families due to the pervasive stigma that exists around leprosy. I didn`t know very much about Hansen`s disease or what to expect at this site before my visit. What I experienced was the pleasure of the company of lovely people whose illness continues to be misunderstood by the majority of the population.

The thought that often comes to my mind here is that we lead very charmed lives back in the United States. Suffering is a universal phenomenon, but there are clearly places where, due to lack of economic resources, the suffering of people is right out there for all to see. It is not possible to hide it behind the doors of a fancy medical office or distract oneself from it with the comforts that many of us enjoy in the States. Though this suffering is often difficult to see and make sense of, I am grateful for the opportunity to share in the lives of the people who I have come in contact with over the past few weeks.

That`s all for now folks!
Aimee Asgarian